PLEASE BE ADVISED: Our offices will be closing at 3pm on Thursday December 24th.
PLEASE BE ADVISED: Our offices will be closing at 3pm on Thursday December 24th.
Youth Sports Safety Week Youth Sports Safety Week offers something for everyone! There are opportunities … Read More
© 2016 New Hampshire Orthopaedic Center
by: Kathleen A. Hogan, MD
In July, I will be traveling to Kinshasa, the capital of The Democratic Republic of Congo with WOGO – Women Orthopedist Global Outreach – on a medical mission to perform knee replacements at the Biamba Marie Mutombo Hospital. There will be over 50 people who travel with us – including nurses, scrub techs, and physical therapists. A tremendous amount of planning goes into these mission trips in order for them to be successful.
A year before the trip, last July, the pre-team consisting of 2 surgeons and 3 team leaders traveled to Kinshasa. They met with the hospital surgical staff and started the process of building a relationship with the orthopedic surgeons. They discussed how we will select our patients, the availability of OR rooms, sterilization equipment and supplies. We also need to determine where the team will stay and eat during their stay here, and identify transportation needs. During every trip we plan educational talks for the health care professionals in the hospital and community service projects in addition to our surgeries, and these also need to be planned ahead of time. This was a quick trip, less than a week, and so much was accomplished.
The Biamba Marie Mutombo Hospital in Kinshasa is the most modern hospital in DRC. Built in 2007, it has 150 beds, an ER, and ICU. The hospital has a partnership with local medical schools. The hospital was built by the Dikembe Mutombo Foundation (dmf.org). Dikembe Mutombo, an NBA legend and all star, has devoted his post basketball life to improving the lives of people in his homeland. He is actively involved in the hospital and will be traveling together with us on our trip in July.
We are shipping all of our supplies to Kinshasa by cargo ship. Although cheaper than shipping by air, this requires that the shipping occur 4-6 months before we arrive. Zimmer -Biomet donates the knee replacement implants. But we also need to bring everything with us that we will need to care for our patients. Surgical drapes, gloves,sutures, and dressings. Betadine to clean the skin. Teds stockings to prevent swelling after surgery. Antibiotics. Crutches and walkers. Bedpans. These are supplies that we take for granted in our hospitals but are not always available in third world countries. Many of these supplies are donated by the hospitals that the surgeons and members of the team work at. Locally, Catholic Medical Center, St. Josephs Hospital, and Bedford Ambulatory Surgical Center have been extremely generous in donating many boxes of supplies for our trip.
Next month, 2 surgeons, a medical doctor, and 3 nurses will travel back to Kinshasa to evaluate patients prior to surgery. In prior mission trips, this evaluation has taken place on the first day of our trip. Patients are seen and evaluated for their suitability for surgery. We will know ahead of time how many patients we will be treating. Patients will know that unless their medical condition has changed drastically, they will be having their knee replaced in July. We expect that some patients will travel quite a distance to the hospital so this will keep them from being disappointed.
These trips are expensive. We are still in the process of raising funds for our trip. A special thanks to the NH Women’s Weekend Tennis League who chose WOGO as their charity to support during the recent Diva Doubles Tennis Tournament! All of the members of the WOGO team are excited about our upcoming trip and focused on making sure the planning and organization is in place to make it successful.
by Kathleen A. Hogan, M.D.
One of the most common complaints after knee or hip replacement is difficulty sleeping. By six weeks after surgery, most people are having less pain in their new joint and increasing their activity. But they often lay awake at night, unable to sleep. Why does this happen and what can be done about it?
Many people have difficulty sleeping in the hospital immediately after surgery. This has many causes, including the stress response to surgery, cytokine release from soft tissue injury, the pain, medications, and the hospital environment. REM sleep (associated with dreaming) is diminished for the first few days after surgery.
Surprisingly, there are no published studies on the frequency of sleep disturbance several weeks or months following joint replacement surgery. However, in one study of patients with broken bones, 41% of patients with shoulder fractures and 36% of patients with knee fractures had difficulty sleeping 3 months after the injury. Even a year later, 20% of patients still reported insomnia.
Insomnia after joint replacement surgery can have many causes. Pain and discomfort are common complaints. Narcotic pain medicines can also disrupt sleep patterns, and decrease the time spent in REM sleep.
What can you do if you are still having difficulty sleeping several weeks after surgery? First of all, make sure you discuss this with your doctor, as she or he may have specific recommendations for you. Good sleep hygiene is important. Avoid caffeine and alcohol immediately before bedtime. Avoid napping during the day. Limit the use of electronic devices in the evening, including your phone. Create a quiet, peaceful atmosphere in your bedroom. Create a peaceful bedtime routine which allows you to relax and instead of dwelling on the discomfort you are having from your surgery. Consider using an eye mask, ear plugs, or a white noise machine. Meditation techniques can be helpful in promoting relaxation. Supporting your leg with pillows can improve comfort.
If you are unable to sleep after 30 minutes, do not lay in bed thinking about how you can not sleep. Get up, go to another room, and read quietly listen to relaxing music, or sit in a chair in a darkened room. Do not watch TV or check email! Using electronic devices will stimulate the brain and cause you to become more awake. Make sure you are getting exposed to some natural light during the day and keep your sleep environment dark as this helps to maintain normal sleep cycles.
What about medications? If you just had surgery, taking your pain medication 30 minutes prior to bedtime is recommended. However, keep in mind that your body may become accustomed to this routine and you may develop insomnia when weaning off these medications. Medications which help with sleep are often habit forming and should be avoided. Some people find Benadryl or melatonin to be helpful, but you should discuss this with your doctor.
Depression is not uncommon after surgery. Sometimes the recovery period can be quite overwhelming. Symptoms can include persistent feelings of sadness and hopelessness. Difficulty sleeping, loss of energy, anxiety, and irritability can also be symptoms of depression.
If you are having problems sleeping after surgery, make sure you talk to your surgeon about it. However, it can take quite some time for the sleep issues after surgery to resolve. It can be a very frustrating aspect of the post operative course after joint replacement surgery. It can take several months for your body to fully recover from the effects of surgery.
By Kathleen Hogan, M.D.
Nothing lasts forever. Articular cartilage allows our joints to move freely without pain. As that cartilage wears out or becomes damaged, arthritis develops. If the resulting pain and deformity from arthritis becomes severe, many joints can be replaced, usually with metal and plastic implants. However, these artificial joints wear out with time and use.
Surgeons expect that the hip and knee replacements that we are implanting today may last twenty years or longer. There are many factors that impact longevity. Patient weight and activity level are important factors. Excessive body weight is a risk factor in the development of arthritis and can contribute to early wear and failure of orthopedic implants. High impact activities such as running and jumping place excessive loads on the components.
When joint replacements were first being developed, one of the biggest problems was to find a material that was durable with a low frictional coefficient, with a low wear rate that did not cause an adverse reaction in the body. Teflon was tried, but very quickly failed. It was slippery, but not durable, and the resulting wear particles resulted in excessive inflammation. Metal on metal implants were also used but also had problems with implant design and manufacturing problems. Eventually, polyethylene, which has many industrial uses was discovered to be an excellent bearing surface. According to legend, Sir John Charnley, the inventor of the modern hip replacement, first implanted polyethylene in his own leg to ensure that it would not cause an adverse reaction in the body!
Since polyethylene was first used in hip replacements in the 1960’s, it has been adapted for use as a bearing surface in knees, shoulders, ankles, and fingers. Modifications have been made to further increase its durability and reduce wear rates. An ultra high molecular weight polyethylene can be used to increase the strength of the material. Most polyethylene used in joint replacement is now highly cross linked by treating the plastic to promote the formation of bonds between carbon fibers. This process increases the wear resistance of the plastic but can diminish strength. The increased durability from cross linking can be diminished, however, if the polyethylene becomes oxidized. The overall wear rate of polyethylene depends on many different patient and implant factors.
When an implant begins to wear out, the wear particles from the polyethylene can cause inflammation. This inflammation can loosen the bond between the joint and the bone. It can also cause pain and instability. If significant wear occurs, a revision surgery may be required.
How long will a joint replacement last? The estimated annual failure rate of hip and knee replacements is 0.5%. Approximately 80% of hip and knee replacements performed 20 years ago are still functioning well. It is expected that joints replaced today will last at least that long and improvements in implant design may further increase that longevity. Patient weight and activity levels have increased, however, and people are having joints replaced at younger ages. For this reason, it is still recommended to get follow up radiographs of joint replacements every few years to ensure that the joint is continuing to function well.
What can you do to increase the longevity of your hip or knee replacement? Although moderate activity is encouraged, it is recommended to avoid high impact activities such as running. Keep your weight within recommended limits. Avoid lifting heavy weights (over 50 lbs) with your job or at the gym. Talk to your surgeon if you have questions about activity after surgery or if you have concerns about your joint replacement.
By Anthony R. Marino, MD
Stress fractures are tiny cracks in bone. Runner’s often have stress fractures in the weight bearing bones of their lower legs and feet. Stress fractures are serious running injuries that pose a significant long term limitation and require considerable time off.
The most common cause of stress fractures is overtraining. Over time your body will respond to the stress of your work-outs. If you increase the intensity, duration or frequency of running too quickly, your body cannot repair itself fast enough and a micro failure occurs. Generally stress fractures are not something that you can run through and a significant time off from running is recommended. You should not begin rehabilitation until after you have seen a professional and received a stress fracture diagnosis.
Avoiding all impact exercises is very important. Cross training by cycling, pool running and swimming is recommended. You should modify your activity if you feel pain. Pool running and swimming are some of the best exercises you can do.
Runners often find it hard to believe that you can keep your fitness at a very high level with cross training or pool running while you allow the stress fractures to heal. Elite athletes who have cross trained while taking extensive time off due to stress fractures have returned to pre-injury performance levels.
When you return to running, you must start very slowly. Then, you very gradually increase your mileage over a long period of time.
Eating disorders increase the risk of stress fractures. When young runners are diagnosed with stress fractures they should be evaluated for possible eating disorders and treated if they are found.
By: Kathleen A Hogan, MD
Weight matters to all of us, whether we’re size 6 or 16. Regular exercise can help with weight maintenance and loss, especially when combined with a healthy diet. Exercise also elevates mood, improves cardiovascular health, and increases bone density. Inactivity on the other hand, contributes to the development of obesity, heart disease, and diabetes. How Much Time Do I Need to Exercise?
People frequently wonder “How much time do I need to commit to exercising to get these benefits?” And “How it is possible to start an exercise program when my joints hurt?”
There is increasing scientific evidence that 30 minutes a day of vigorous activity may be just as beneficial to overall health and fitness levels as an hour or more of activity. The American College of Sports Medicine recommends 150 hours of moderate activity a week. This can be accomplished in only 30 minutes per day for 5 of 7 days.
Shorter periods of activity are as effective as a prolonged workout. Plus, people are more likely to continue exercising and feel less fatigued when they stick to 30 minutes per day. Strength and flexibility exercises should be performed twice weekly in order to maximize health benefits. In addition, balance and agility exercises can help to prevent falls in older adults. Strengthening the core muscles can help to decrease the incidence of back pain.
Every day in clinic I have patients tell me that they couldn’t possibly exercise because their joints hurt or because they are too overweight. That is simply not true. Many activities can be modified to minimize the stress on the joints.
The pool is an excellent alternative to land based activities. An exercise bike, elliptical trainer, and rowing machines all minimize joint stresses compared to running. Upper and lower body weight training is possible even for those who have arthritis in their hips or knees. Strength training builds muscle and increases bone density. Strong muscles can help decrease stress on joints.
If you do not routinely exercise or lift weights, you can easily injure yourself. I often recommend starting with a physical therapy program with a goal of designing a home exercise program based around specific joint ailments. But this only works if you commit to following through with the exercises you learn in therapy.
How sedentary are you? I would suggest downloading a free pedometer app for your phone and keeping track of the number of steps you take daily for a week. A reasonable goal is 10,000 steps (5.2 miles) per day. If you have a desk job or sit most of the day you will likely take far fewer steps unless you add additional activities to your day. Sometimes having a reminder of just how sedentary one has been can be the encouragement needed to increase activity. Gradually work towards the very reasonable goal of doing something physically active for 30 minutes each day. Make sure you talk to your doctor about starting any exercise program, especially if this is new to you.